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PubMed2004

"New Choices" for women with addictions: perceptions of program participants.

BACKGROUND: Substance use in pregnancy is a major public health problem. It can have profound effects on pregnancy outcomes, and childhood health and development. Additionally, women who use substances have their own health-related issues. Although intervention is important, these women often have difficulty using traditional systems of care. The New Choices program is a centralized, multi-sector approach to service delivery that has attempted to overcome barriers to care by offering one-stop shopping in a supportive environment. As part of an evaluation of this program designed for women who are pregnant and/or parenting young children, interviews were conducted with participants to gain insight into their experiences in New Choices and perceptions of any changes attributed to program involvement. METHODS: A qualitative, exploratory design was used to guide data collection and analysis. Four women participated in a focus group interview and seven women agreed to individual interviews over the course of the program evaluation (N = 11). A semi-structured interview guide was used to explore women's experiences in New Choices and their perceptions of the program and its impact. The interview data were analyzed using NVivo software and an inductive approach to data analysis. RESULTS: The emergent themes captured women's motivations for attending New Choices, benefits of participation, and overall quality of the program. Children were the primary motivating factor for program enrollment. Perceived benefits included decreased substance use, improved maternal health, enhanced opportunity for employment, increased access to other resources, enhanced parenting skills, and improved child behaviour and development. Women highly valued the comprehensive and centralized approach to service delivery that provided a range of informal and formal supports. CONCLUSIONS: Interview findings endorse the appropriateness and potential efficacy of a collaborative, centralized approach to service provision for women with substance use issues. Although the findings provide insight into an alternative model of service delivery for women with addictions, future research is needed to evaluate the effectiveness of the intervention. Research also is needed to determine which program components or constellation of components contribute to desired outcomes, and to learn more about processes that underlie changes in behaviour.

Adult↗
PubMed2006

Meeting the need to belong: predicting effects of a friendship enrichment program for older women.

PURPOSE: This study explores the effects of participation in a program designed to enrich friendship and reduce loneliness among women in later life. Several hypotheses based on the need to belong, socioemotional selectivity theory, and the social compensation model were tested. DESIGN AND METHODS: Study 1 involved two measurement points, one at the end of the program and the other 1-year later. Study 2 used a pretest-post-test control group design with a follow-up measurement. A combination of semistructured interviews and structured questionnaires was used to collect data. A comparison group was also drawn from a nationwide representative sample. RESULTS: Participants were characterized by deprivation on the need to belong; that is, loss of a partner, higher levels of loneliness and negative affect, and lower positive affect compared with a nationwide representative sample of same-aged women. Participants were more likely than women in a control group to report the development of new friendships and an improvement in friendship. The combination of new and improved friendships contributed to a significant reduction in loneliness within a year. There was no evidence of satiation of the need to belong among those who did not expand or improve friendships. Loss of a partner had no influence on friendship development; however, age did. Older participants were less likely to improve friendships. IMPLICATIONS: The action-oriented approach that focused on friendship development in this intervention might be applied to other goals considered important in later life (optimal health, autonomy, harmonious family relations).

Aged↗
PubMed1987

'Metamorphosis': computer-assisted rotational analysis and interspatial distribution of nuclear structures from serial ultrathin sections.

'Metamorphosis' is a group of computer programs designed to permit rapid three-dimensional analysis and generation of models of nuclei cells from digitized data. Infinite exterior views are possible using the rotation program and the user has the added ability to enter the object and peer out. This permits analysis of structural associations from any perspective. Since many chromosome associations cannot be abstracted without a computer, using rotation and cluster analysis reveals obscure relationships. This concept becomes important when proposing theories involving interactions between two or more objects. The program is written in BASICA and designed for use on IBM-compatible personal computers equipped with a digitizer. Three-dimensional transformations are accomplished via matrix manipulation which permits rapid generation of new images.

Animals↗
PubMed2001

Technology as an aid to coping with caring: a usability evaluation of a telematics intervention.

This paper presents evaluation data for an interactive software program designed to provide family carers with information, advice and psychological support by way of feedback of their coping capacity. The multimedia program consists of an information-based package that provides carers with advice on health promotion and relaxation and offers them a range of coping strategies (for example, positive self-talk, assertiveness training and relaxation tapes and videos). The program also includes a carer's self-assessment instrument, designed to provide both family and professional carers with information to assess how family carers are coping with their care-giving role. As part of the usability evaluation, casual users (family carers, professional carers and older people) were invited to test the program and were administered a program evaluation questionnaire measuring quality and efficiency in utility and usability. Quantitative data were analysed by using the Statistical Package for the Social Sciences (SPSS) and qualitative data were analysed by content analysis. Findings indicated that the program is visually pleasant, easily understood, responds quickly and corresponds with user expectations. A number of recommendations are made for improvement of the navigation of the program.

Adaptation, Psychological↗
PubMed1991

A dietary education program for hypercholesterolemic children and their parents.

A parent-child autotutorial dietary education program for 4- to 10-year-old, hypercholesterolemic children and their families was developed and pilot tested. The 10-lesson program, designed for weekly use at home, uses a "talking-book" approach (audiotapes with accompanying picture booklet) for the child. Parents are provided with information on ways to make recommended dietary changes, along with hands-on activities to do with the children. To help match the instructional approach to the wide developmental range within the children's age span, materials are divided into three program levels that use different story characters and concept presentations. During program development, evaluation by two children (and their parents) for each of the program levels guided the design and refinement of the lessons. A pilot test among 22 hypercholesterolemic children (whose treatment was limited to diet modification) revealed that children within the 4- to 10-year age range liked the "talking-book" approach and identified positively with the story characters. Parents indicated that their materials were clear and helpful. Between the baseline and 3-month follow-up visits, the children exhibited a significant increase in knowledge of heart healthy foods, a decrease in total fat consumption that approached significance, and a significant decrease in plasma low-density-lipoprotein cholesterol values.

Adult↗
PubMed1999

Computerized pediatric telephone triage and advice programs at children's hospitals: operating and financial characteristics.

OBJECTIVE: To describe the operating characteristics, financial performance, and perceived value of computerized children's hospital-based telephone triage and advice (TTA) programs. DESIGN: A written survey of all 32 children's hospital-based TTA programs in the United States that used the same proprietary pediatric TTA software product for at least 6 months. MAIN OUTCOME MEASURES: The expense, revenues, and perceived value of children's hospital-based TTA programs. RESULTS: Of 30 programs (94%) responding, 27 (90%) were eligible for the study and reported on their experience with nearly 1.3 million TTA calls over a 12-month period. Programs provided pediatric TTA services for 1560 physicians, serving an average of 82 physicians (range, 10-340 physicians) and answering 38880 calls (range, 8500-140000 calls) annually. The mean call duration was 11.3 minutes and the estimated mean total expense per call was $12.45. Of programs charging fees for TTA services, 16 (59%) used a per-call fee and 7 (26%) used a monthly service fee. All respondents indicated that fees did not cover all associated costs. Telephone triage and advice programs, when examined on a stand-alone basis, were all operating with annual deficits (mean, $447000; median, $325000; range, $74000-$1.3 million), supported by the sponsoring children's hospitals and their companion programs. Using a 3-point Likert scale, the TTA program managers rated the value of the TTA program very highly as a mechanism for marketing to physicians (2.85) and increasing physician (2.92) and patient (2.80) satisfaction. CONCLUSIONS: Children's hospital-based TTA programs operate at substantial financial deficits. Ongoing support of these programs may derive from the perception that they are a valuable mechanism for marketing and increase patient and physician satisfaction. Children's hospitals should develop strategies to ensure the long-term financial viability of TTA programs or they may have to discontinue these services.

Consumer Behavior↗
PubMed2005

Screen-and-treat approaches for cervical cancer prevention in low-resource settings: a randomized controlled trial.

CONTEXT: Non-cytology-based screen-and-treat approaches for cervical cancer prevention have been developed for low-resource settings, but few have directly addressed efficacy. OBJECTIVE: To determine the safety and efficacy of 2 screen-and-treat approaches for cervical cancer prevention that were designed to be more resource-appropriate than conventional cytology-based screening programs. DESIGN, SETTING, AND PATIENTS: Randomized clinical trial of 6555 nonpregnant women, aged 35 to 65 years, recruited through community outreach and conducted between June 2000 and December 2002 at ambulatory women's health clinics in Khayelitsha, South Africa. INTERVENTIONS: All patients were screened using human papillomavirus (HPV) DNA testing and visual inspection with acetic acid (VIA). Women were subsequently randomized to 1 of 3 groups: cryotherapy if she had a positive HPV DNA test result; cryotherapy if she had a positive VIA test result; or to delayed evaluation. MAIN OUTCOME MEASURES: Biopsy-confirmed high-grade cervical cancer precursor lesions and cancer at 6 and 12 months in the HPV DNA and VIA groups compared with the delayed evaluation (control) group; complications after cryotherapy. RESULTS: The prevalence of high-grade cervical intraepithelial neoplasia and cancer (CIN 2+) was significantly lower in the 2 screen-and-treat groups at 6 months after randomization than in the delayed evaluation group. At 6 months, CIN 2+ was diagnosed in 0.80% (95% confidence interval [CI], 0.40%-1.20%) of the women in the HPV DNA group and 2.23% (95% CI, 1.57%-2.89%) in the VIA group compared with 3.55% (95% CI, 2.71%-4.39%) in the delayed evaluation group (P<.001 and P = .02 for the HPV DNA and VIA groups, respectively). A subset of women underwent a second colposcopy 12 months after enrollment. At 12 months the cumulative detection of CIN 2+ among women in the HPV DNA group was 1.42% (95% CI, 0.88%-1.97%), 2.91% (95% CI, 2.12%-3.69%) in the VIA group, and 5.41% (95% CI, 4.32%-6.50%) in the delayed evaluation group. Although minor complaints, such as discharge and bleeding, were common after cryotherapy, major complications were rare. CONCLUSION: Both screen-and-treat approaches are safe and result in a lower prevalence of high-grade cervical cancer precursor lesions compared with delayed evaluation at both 6 and 12 months. Trial Registration http://clinicaltrials.gov Identifier: NCT00233727.

Acetic Acid↗
PubMed1989

Experience with mandatory continuing education in a teaching hospital.

Mandatory continuing education (MCE) has the potential to create unwilling learners who, if given a choice, may not participate in continuing education programs. Participants of two MCE programs conducted at a large teaching hospital responded to a survey assessing their perception of and attitudes toward MCE and their perceptions of program effectiveness. Results of the study indicated that mandating the programs did have adverse effects on participants' perceived outcomes and on the likelihood of their voluntarily attending future programs. Descriptions of the two programs, design and results of the study, and suggestions on how to approach mandatory programming are presented.

Attitude of Health Personnel↗
PubMed1989

Computer-assisted evaluation of polydisperse two-dimensional gel patterns of polysaccharide-protein conjugate preparations with regard to size and net charge.

Native Hemophilus influenzae polysaccharide-protein conjugate particles were analyzed by a two-dimensional agarose electrophoresis procedure. In view of their preparation by random chemical crosslinking, the conjugates necessarily exhibit a polydisperse two-dimensional gel pattern which varies depending on the conditions of the particular preparation. The polydisperse patterns were interpreted with regard to the size and surface net charge density of the conjugate on the basis of the extended Ogston model. Data processing was performed by a new program, designated ZWEIDI.DO, written in the language of M-LAB (modeling laboratory). The program computes particle and gel fiber specific parameters from the positions of standards and unknown(s) on the two-dimensional gel using a simultaneous linear least-square curve fitting routine. Based on these calculations, the program serves to compute a nomogram of iso-size and iso-free-mobility profiles. Superimposing these profiles on the gel patterns, the size and free mobility range of the polydisperse conjugate mixtures is obtained. Potentially, the procedure could serve as a tool for quality control in the production of conjugates as vaccines and for the physical characterization of polydisperse subcellular particles and vesicles.

Bacterial Proteins↗
PubMed2006

Structure-based de novo design, synthesis, and biological evaluation of the indole-based PPARgamma ligands (I).

MCSS and LeapFrog, two de novo drug design programs, were used for the novel indole-based PPARgamma ligands' study. The designed compounds were synthesized and tested for the PPARgamma protein binding activities in vitro. Out of the compounds that were synthesized, two molecules (compounds 14d and 7d) possessed potent PPARgamma protein binding activity close to rosiglitazone in vitro.

Algorithms↗
PubMed2006

Predictors for resident success in otolaryngology.

BACKGROUND: This study aimed to determine predictors for otolaryngology resident success using data available at the time candidates are interviewed (eg, medical school attended, letters of recommendation, test scores) and data that emerge during residency. STUDY DESIGN: We performed a retrospective cohort study of 36 residents who entered our program between 1983 and 1993. RESULTS: Seventy percent of Alpha Omega Alpha (AOA) members and 13% of nonmembers were in the highest tertile based on faculty ranking (p<0.01), and candidates with an exceptional trait were more likely than those without an exceptional trait to rank in the highest tertile (57% versus 10%, p<0.01). AOA membership was also related to current academic appointment (p=0.02). Significant correlations included United States Medical Licensing Examination (USMLE) I score, year 2 in-training score (0.48, p=0.03), and years 3 and 4 in-training score and faculty ranking (minus 0.39, minus 0.50, respectively, p 50% of the interviewers (p<0.05 for both). CONCLUSIONS: In our program designed to train academic otolaryngologists, postresident success was strongly predicted by having an exceptional trait and AOA membership. Success during residency was predicted by interviewer's impression of the candidate and a USMLE I score>570. Knowledge of these factors at the time of the resident interview could increase the likelihood of selecting the most appropriate candidates for academic otolaryngology. Resident success is a complex outcome, and other unmeasured and unexamined characteristics can provide additional insight into choosing successful residents.

Adult↗
PubMed1993

The use of vaginal ultrasound for monitoring endometrial preparation in a donor oocyte program.

OBJECTIVE: To determine whether vaginal sonographic measurements can be used to monitor the endometrial preparation of recipients in a donor egg program. DESIGN: Prospective clinical trial. SETTING: University hospital-based IVF and donor egg program. PATIENTS: Twelve women without ovarian function. INTERVENTIONS: [1] In a control cycle, patients received 4 or 8 mg of oral E2 and vaginal ultrasound (US) daily until endometrial thickness > or = 6 mm with a triple-line pattern (favorable endometrium) was seen. Progesterone (P) in oil, 100 mg/d, was then added. [2] An endometrial biopsy was performed on day 7 of P therapy. [3] In a treatment cycle, US monitoring of endometrial development during estrogen (E) administration was used; and ET was performed on the 3rd day of P therapy. RESULTS: In the control cycle, 8 mg/d or 4 mg/d of micronized E2 resulted in favorable endometrium development in all patients in a mean time of 5 and 7 days, respectively. After P treatment, only 1 of 12 endometrial biopsies was in phase. In the treatment cycles, the overall clinical pregnancy rate (PR) was 42%. In those patients with a favorable endometrium in the E replacement phase, before addition of P, the PR was 62.5%. All of the pregnant patients but only 42.8% of the nonpregnant patients had a favorable endometrium on US before the addition of P. CONCLUSION: An endometrium that is favorable for implantation can result from the use of a simple fixed dose of E2, with higher doses achieving favorable endometrial development in shorter time. Vaginal sonography of endometrial development before P administration is more accurate than endometrial biopsy in predicting a successful donor egg cycle. Endometrial preparation in donor oocyte programs can be simplified by the use of vaginal US monitoring.

Endometrium↗
PubMed1997

A computer program to aid in visual concept development in dentistry.

Beginning dental students normally receive their first exposure to the study of tooth forms (morphology) through a dental anatomy laboratory course in which they are required to reproduce tooth morphology, usually with wax. The fabrication of a tooth in wax requires proper visual recognition skills and fine eye-hand coordination. Many students struggle with one or both of these. A computer program, designed to teach recognition concepts, was delivered to three groups of beginning freshman dental students in conjunction with their dental anatomy laboratory course while a group of their classmates served as the controls. This study investigated (1) instructional design and interface improvement and (2) the best method to implement the computer program. Experimental and control groups all received normal daily critiques of their course project work. After completion of the computer program, all groups were tested with a recognition-based examination as well as with a practical examination, requiring the reproduction of a tooth in wax. All experimental groups scored better than the control group on both examinations. Results indicated that computer-based instruction may be a useful means to foster visual concept development. An expanded program, using better graphics, animation and movies is currently under development.

Anatomy↗
PubMed2000

Treatment of childhood anxiety: developmental aspects.

This review focuses on research on the cognitive-behavioral treatment of childhood anxiety disorders. Early forms of therapy for childhood anxiety were borrowed from adult treatment models. More recently, there has been a recognition of the need to design treatment from a child-based perspective. Consequently, several cognitive-behavioral programs designed specifically for children and youth have been both developed and evaluated. The importance of parental involvement has also been recognised in these treatment innovations. However, a number of developmental factors have yet to be given adequate consideration in both the research and practice of childhood anxiety treatment. The article highlights some of these factors including issues of individual, family and cultural variation.

Adolescent↗
PubMed2003

Mimicking photosynthesis in a computationally designed synthetic metalloprotein.

While advances in protein design have made possible the construction of protein architectures with nativelike properties and predictable structures and function, there are as of yet no examples of functional, protein-based, solar energy conversion systems. This communication describes the design and characterization of an artificial reaction center (RC) protein that closely resembles the function of the natural photosynthetic RC. The synthetic protein, designed by the protein design program CORE, participates in multiple reduction/oxidation cycles with exogenous acceptors/donors following photoexcitation. The designed metalloprotein, aRC, consists of a tetrahelical bundle functionalized with two bis-histidine bound metal cofactors: a Ru(bpy)2 moiety and a heme group. Two distinct bis-histidine binding sites were engineered for each of these metal centers. Photoexcitation of aRC results in rapid ET from the RuII complex to the heme group (kET >/= 5 x 1010 s-1) yielding a long-lived (70 ns) charge-separated state (CSS), RuIII/FeII. This long-lived CSS participates in subsequent ET reactions with exogenous donors and acceptors in multiple photocycles, thus mimicking the basic function of native photosynthetic RCs. This study illustrates the successful design and construction of a protein-based functional charge separation device using a combination of automated computational protein design and knowledge of the engineering principles of biological electron tunneling extracted from natural electron-transfer systems. To our knowledge, this represents the first example of a functional protein-based artificial reaction center.

2,2'-Dipyridyl↗
PubMed1997

Increasing general practitioner skills with patients with serious mental illness.

This report describes a clinical training program designed to increase general practitioner involvement with a public mental health service. The program involved one half-day clinical session per week and one two-hour formal training seminar per month, over a six-month period. Prior to training, participants demonstrated major clinical and theoretical skill deficits when assessing patients with serious mental illnesses. While specific knowledge of psychiatry increased by the end of the training program, little change in clinical interview skills was evident. Current initiatives to enhance general practitioner involvement in mental health care may be hampered if these skill deficits are not directly addressed in relevant shared care programs.

Attitude of Health Personnel↗
PubMed1977

Sequence data handling by computer.

The speed of the new DNA sequencing techniques has created a need for computer programs to handle the data produced. This paper describes simple programs designed specifically for use by people with little or no computer experience. The programs are for use on small computers and provide facilities for storage, editing and analysis of both DNA and amino acid sequences. A magnetic tape containing these programs is available on request.

Amino Acid Sequence↗
PubMed1992

Early-retirement incentive programs for medical school faculty.

The Association of American Medical Colleges surveyed the principal business officers of all 126 accredited U.S. medical schools in late 1991 in order to learn about their retirement benefit programs for faculty and whether early-retirement incentive programs were being used. A total of 115 of the schools provided usable responses, which the author reports for all schools, public schools, and private schools. For all schools, defined-contribution plans (based on employer's and employee's contributions plus investment earnings) were the preferred type of retirement benefit program (77%, or 89, of the responding schools). Defined-benefit plans (based on a formula that uses variables of age at retirement, years of service, and salary) were available at 37% (43) of the schools. Early-retirement incentive programs had been used by 70% of the responding schools in the five-year period 1987-1991. Sixteen schools provided descriptions of their formal early-retirement programs, which are summarized. The author observes that, although nearly three-fourths of the responding schools are familiar with the use of the incentive programs, these programs have resulted in few actual early retirements. He discusses why this may be true and compares the pros and cons of formal and ad hoc programs. He concludes that no single program can be considered best; each institution must work with its faculty to design programs to meet institutional goals and faculty interests.

Faculty, Medical↗